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AJP Rep. 2016 Oct;6(4):e355-e358.

Pregnancy Complicated by Gorham-Stout Disease and Refractory Chylothorax.

Author information

1
Department of Medicine, Stanford University, Palo Alto, California.
2
Department of Surgery, University of California, San Francisco, California.
3
Department of Pediatrics, Stanford University, Palo Alto, California; Departments of Obstetrics and Gynecology, Stanford University, Palo Alto, California.
4
Department of Pediatrics, Stanford University, Palo Alto, California.
5
Division of Cardiovascular Medicine, Stanford Center for Lymphatic and Venous Disorders, Stanford University School of Medicine, Stanford, California.

Abstract

Introduction Gorham-Stout Disease (GSD) is a rare disorder of bony destruction due to lymphangiomatosis, and is often triggered by hormones. One complication of GSD is the development of chylothorax, which carries a high mortality rate. Very little experience has been published to guide management in GSD during pregnancy to optimize both fetal and maternal health. Case Study A 20-year-old woman with known GSD presented with shortness of breath at 18 weeks of pregnancy, due to bilateral chylothoraces which required daily drainage. To minimize chylous fluid formation, she was placed on bowel rest with total parenteral nutrition (limiting lipid intake) and received octreotide to decrease splanchnic blood flow and chylous fluid drainage. Treatment options were limited due to her pregnancy. Twice daily home chest tube drainage of a single lung cavity, total parenteral nutrition, octreotide, and albumin infusions allowed successful delivery of a healthy 37 weeks' gestation infant by cesarean delivery. Discussion This case illustrates the management of a rare clinical disease of bone resorption and lymphangiomatosis complicated by bilateral, refractory chylothoraces, triggered by pregnancy, in whom treatment options are limited, and the need for a multidisciplinary health care team to ensure successful maternal and fetal outcomes.

KEYWORDS:

Gorham–Stout disease; chylothorax; octreotide; pregnancy; total parenteral nutrition

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